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EAU 2018: In Vitro Effects Of Novel Coating Agents On Bacterial Biofilm Development On Ureteral Stents

Copenhagen, Denmark (UroToday.com) Ureteral stenting for the treatment of hydronephrosis is commonly used and considered the gold standard for the short-term management of distal ureteral stones. However, ureteral stenting does not come without side effects such as pain and discomfort for up to 80% of patients. Previous studies in efforts to optimize form material have not been shown to be advantageous in managing these side effects and, even further, biofilm development due to transient bacteriuria can cause severe incrustation (and, consequentially, stent obstruction). These complications ultimately lead to increased stent replacement frequency and incidence of severe complications.

Dr. Schoeb (MD) of the University of Freiburg, Department of Urology presents an in vitro analysis to investigate the antimicrobial effects of a novel polymer (PDMAA) with a high resistance to protein absorption.

Glass slides coated with PDMAA and simple polyurethrane (PU) versus hydrophilic ureteric stents and PU stents were incubated in sterile human urine for 48 hours, in effort to mimic the conditions encountered in vivo. Colonization was then stimulated by adding known uropathogens and adherent bacteria were solubilized by ultrasound afterwards. The primary outcome measure was the count of colony forming units (CFU) after the 48 hour colonization period.

Overall, PDMAA reduced adherent E. coli about 4-fold when assessed via CFU (PDMAA 32 versus PU 142, p<0.0001). Furthermore, hydrophilic coating increased E. coli adherence about 7-fold (non-coated 61.5 versus hydrophilic 429.5, p<0.001).

Dr. Schoeb notes that the commercially available hydrophilic stent and commercially available PI stent without coating are the most commonly used in URS. However, while this study found that PDMAA reduces surface adherence of E. Coli, it is limited in the use of E. Coli, small numbers, and the in vivo nature of testing. Further experimental and clinical investigations are required before such optimization of stent coatings can become standard of care.

Speaker: Dr. Schoeb

Authors: Dressler F.F. 1 , Szell T. 1 , Goelz H. 2 , Miernik A. 1 , Brandstetter T. 3 , Scherag F. 3 , Schoeb D.S. 1.

Written by: Linda M. Huynh, B.S., University of California-Irvine, at the 2018 European Association of Urology Meeting EAU18, 16-20 March, 2018 Copenhagen, Denmark